My Doctor Says I Need Coronary Artery Bypass Surgery. Now What?

How Bypass Surgery Works

The coronary arteries supply the heart muscle with blood and oxygen. These arteries are like tiny tubes that can become blocked. This surgery is called Coronary Artery Bypass Grafting (CABG). A blood vessel is taken from the legs, arms, and/or chest and is placed onto the heart artery beyond the blockage.

This allows the blood to flow around the blockage. This feeds the heart muscle with more blood and oxygen. "McLeod has dedicated Open Heart Rooms," said Dr. S. Cary Huber of McLeod Cardiothoracic Surgical Associates, "fully equipped operating rooms designed specifically for cardiac surgery." Here are some common questions heart patients ask:

Q: How will CABG help?

A: CABG improves blood flow to the heart. This may: Stop chest pain or angina. Help you to exercise. Reduce the need for some or all heart medication. Help you feel less tired. Help you to live longer.

Q: What is involved in the surgery?

A: A McLeod Heart Team will perform the bypass surgery. The heart team is made up of skilled nurses, surgical assistants, perfusionists, and anesthesiologists all led by a cardiac surgeon. An incision or cut will be made in the middle of the chest. The sternum (breastbone) will be opened so the surgeon can reach the heart. An incision may be made in a leg (saphenous vein) or arm (radial artery) to obtain the conduits for bypass, and, in most cases, at least one artery from the chest (internal mammary artery) is also used. The veins may be retrieved through a procedure called endoscopic vein harvesting, which is a procedure being used at McLeod to minimize leg discomfort and to improve the leg's cosmetic result. Then these conduits are sewn to the coronary arteries to construct the bypass of the blocked coronary circulation. When the bypass is over, the surgeon will reconnect the breastbone with wires and then close the incision site.

Q: How long is the surgery?

A: Patients can expect to be in surgery for 2 to 4 hours. A Heart Team member will call the family when they begin. Another call will be made during the surgery and then again at the end of the surgery. "We want to relieve family members' anxiety by keeping them as informed as possible on the status of their loved one's surgery," said Dr. Huber.

Q: What happens after surgery?

A: After surgery, patients are taken to the Heart and Vascular Intensive Care Unit. In the Heart and Vascular ICU, there is a one-to-one patient to nurse ratio for the first eight hours after surgery. From the ICU, heart surgery patients would move to the cardiac telemetry floor. Soon after surgery, the nurse in the Heart and Vascular ICU will begin exercising the patient. The exercises, called Range-of-Motion exercises (ROM) help muscles get more blood flow to them. They also help the patient build up strength for when they are able to get out of bed, which would normally be six to twelve hours after surgery.

Q: When can I go home?

A: Most patients go home 4 to 5 days after surgery. While at home, Dr. Huber recommends calling a doctor at once if patients experience any of the following problems: Feeling very weak. Feeling very dizzy or fainting. Fever of 101 degrees or greater. Extreme shortness of breath. Very rapid heart rate. Very slow heart rate. Weight gain of 3 to 5 pounds in 1 to 2 days. Extreme swelling in legs or ankles. Not able to eat. Extreme nausea, vomiting, or diarrhea. Very red incisions with drainage. Chest pain that is not soreness from surgery. Severe chest pain or back pain when breathing deeply.

Q: Will I see my heart surgeon again?

A: Heart surgery patients should plan to start their visits with their heart surgeon 1 to 2 weeks after going home and their cardiologist in 4 to 6 weeks.

Q: How long is recovery?

A: It is important to follow all recovery guidelines outlined by the physician and take all medications prescribed. For 2 to 3 months after surgery, heart patients should not push or pull with their arms and should not twist their chest as the breastbone needs time to heal. They should also not drive a vehicle for one month. Bypass surgery is not a cure for coronary artery disease. "It is up to each individual to make positive changes in their lifestyle, including eating right, quit smoking if they are smokers, and to participate in a regular exercise program," said Dr. Huber. "McLeod has a wonderful Cardiac Rehabilitation program at the McLeod Health & Fitness Center that we recommend for patients with heart disease.

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